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“Mental illness,” mass murders, and #yesallwomen – part 1

Trigger warning for violence and abuse. This first post will focus primarily on the “mental illness” portion, while the next will focus on the #yesallwomen portion.

I was in elementary school when I first heard about the mass shooting that happened at Columbine High School. I was not old enough to understand how something like that could have happened. The end of my senior year of high school was marred by the shootings at Virginia Tech. July 2012 brought with it a movie theater mass murder in Aurora, Colorado. In April 2013, two bombs went off at the finish line of the Boston Marathon. And most recently, the horrific shootings that happened in Santa Barbara over the weekend.

In my relatively short life, I’ve seen dozens of stories on the news and in social media sites in regards to events such as these. And each time, the same questions come up. Questions about parenting, how the individual got access to guns, and the motivation behind the attacks. These attacks spark debates about gun control and mental health issues. And without fail, the same questions are always asked: “was he mentally ill?” “Would these things have happened if he just got some help?”

A few months ago, a man came into my office for an intake. When you do an intake, you simply go in, ask a handful of questions, create an initial treatment plan, and set that person up with the level of care that corresponds with their current symptoms. You don’t really know what to expect. Now, I’ve certainly had my fair share of nerves prior to meeting with clients, but at this point, I felt like I was finally getting the hang of things and had no real reason to be nervous.
And just as I was beginning to feel comfortable, I began to feel queasy. From the moment he entered the room, I felt incredibly on-edge, and it didn’t stop until a few hours after the intake was complete.

Each answer was more chilling than the next. I spent a significant amount of energy ensuring that I chose the right words and maintained a straight face in hopes that a flat affect would mask my anxiety. My discomfort was apparently not evident, and perhaps the scariest part of the experience was having him tell me that I was “very professional” (after all, it felt very strange to not show any reaction to this man’s words). Hearing the pain that this man caused to others (sexual assault, brutal violence, etc) without the smallest increment of remorse shook me to the point where I had to cancel my next session and cry in my supervisor’s office. I’ve had my share of challenging clients, but I can relate to almost everyone on an empathetic, human level. Is it possible to do that with a person who does not possess any form of empathy? This moment was when I admitted to myself the thing that no therapist ever wants to admit: I can’t help this person.

I’ve often thought to myself what would have happened if I was the therapist of any of these people that caused these horrific tragedies. I wonder if they ever did receive any type of mental health care, and if so, what that person’s mental health treatment team must be experiencing. It has not been scientifically proven that all serial killers and mass murderers are sociopaths and vice versa (
or, diagnostically speaking, have Anti-Social Personality Disorder, though it should be noted that the two terms are not necessarily synonomous); however, I do know that there is a large correlation. I also know that it’s an unfortunate reality that once someone has developed ASPD, it becomes very difficult, almost impossible, to treat. Because the individual does not have the capacity for empathy and has developed a pattern of manipulative and exploitative behaviors, they often mimic remorse and manipulate therapists and psychiatrists in order to get what they want.

While certain symptoms can be subsided with years of therapy and various medication cocktails, a personality disorder cannot be “cured.” And no matter how hard the therapist works, he or she cannot be held responsible for the actions of someone else. Legal implications are difficult as well (another blog post for another time), as confidentiality cannot be breached unless the client specifically indicates that he or she has an active plan to harm him/herself or someone else. I do know that if I were the therapist of someone who ended up killing many people, it would be very difficult to move past that, and feelings of guilt, anger, and shame would be overwhelming. It is easy to blame the mental health system, but a mental health professional, or anyone else, cannot control another individual’s behavior. But it’s sometimes hard to remember that.

I cannot say for sure whether or not Elliot Rodger or the other shooters could be diagnosed with Anti-Social Personality Disorder. What I do know is that I hear people bring in a variety of mental health diagnoses being thrown out in association with the attacks. Most recently, I saw an argument that stated Elliot had been diagnosed with Asperger’s Syndrome, which may have contributed to the attacks. That this occurred because he was “mentally ill,” and we need to talk about mental health.

So yes, let’s talk about mental health. Let’s talk about how mental illness is NOT always an indication of violence and does not always imply a predisposition to aggressive behavior. When someone associates Asperger’s Syndrome (or Major Depressive Disorder, or Bipolar Disorder, or any other mental condition found in the DSM) with these mass killings, the conversation about mental health becomes very misinformed. Mental health issues can be caused by a significant number of factors, but most people struggling with mental illness are just trying to live their daily lives to the best of their abilities. Isolating individuals with mental illnesses and automatically lumping them into the category of violent criminals only perpetuates the notion that mental illness is something that needs to be stigmatized. So many individuals who experience mental health issues do not enter treatment due to shame and stigmatization. Because instead of being seen as humans, they’re viewed by the world as “crazy”!or “abnormal.”

Of course, mental health is going to be brought into a conversation about someone who has harmed a lot of people. And it’s easy to place blame on mental health problems, but that only stigmatizes mental health even more and pushes those who may feel as though they need treatment away from receiving it. We can talk about mental health. But let’s acknowledge its complexities, its stigma, and a move toward societal acceptance of mental health issues, rather than using to blame the aggressive and violent behavior of a few individuals.

There’s more – a lot more – that needs changing. But I’ll save that for the next post.

Every time there’s another mass shooting, I have to avoid the news for a week or two. I can’t stand to hear news anchors and “experts” talk about how this was caused by mental illness. They always want to diagnose the shooter, but they’ve never seen or talked to him. I’m not a psych clinician, but I know you can’t do a valid ex post facto diagnosis on someone you’ve never even spoken to. My most recent diagnosis required four hours of interviews with a psychiatrist who was an expert in the particular disorder, conversations with my family or origin, and several hours of interviews with my therapist and outpatient treatment team. The whole process took about a month. I don’t understand how any self-respecting clinician can get on TV or radio news and spout out diagnoses the way they do. It undermines the legitimacy of responsible diagnostic procedures.

It’s also incredibly stigmatizing for those of us who live with mental illnesses. There’s been a lot of work done around reducing stigma, but my experience is that it’s created a dichotomy of mental illnesses: there are the “okay mental illnesses” like mild depression, anxiety, and sometimes mild bipolar, and then there are the “scary crazy mental illnesses,” which is anything more severe. I’m what you’d call severe: I’ve been hospitalized more than a dozen times, been involuntarily committed once, had nearly 30 ECT’s…you get the idea. I face a lot of stigma that my friends with mild-moderate depression have never experienced, and that often included people assuming that I’m dangerous.

I work as a political organizer, so I pay a lot of attention to the political discussion about gun violence, particularly after mass shootings. Our politicians are contributing to the stigma we deal with when they talk about how we have to keep guns away from violent criminals and mentally ill people. That’s usually exactly how it’s phrased: we’re put on the same level as murderers, even though people with mental illness are much more likely to be the victims of violence than the perpetrators. I’ve memorized statistics: you’re statistically more likely to be killed by a shark than a schizophrenic, and the single greatest predictor for gun violence is alcohol use, not mental illness. We should keep guns away from some people with mental illness–but because they’re likely to hurt themselves, not others, and suicide attempts in households with firearms are much more deadly than in those without. But time and again, I hear politicians I’ve voted for and even campaigned for talking about me and others like me as though we’re a great threat. When I hear that, it feels like violence against me.

But there are a few politicians who see that kind of rhetoric as a problem and are working to change it, which I really hope catches on. I’m working on a campaign for one of those candidates now. I feel in love with her as a candidate the first time I heard her debate on the campaign trail. There was a question about preventing gun violence, and all her primary opponents’ responses included stigmatizing remarks about people with mental illness. Then she spoke and said we needed to separate the issues of gun violence and mental health care. I was like, “Who is this woman and how can I work for her?” It gives me hope to hear some lawmakers talking about it in those terms. It’s only a few of them now, but I hope it’ll catch on.

(Sorry, I kind of wrote you a novel here. It’s an issue I have a lot of feelings about, and it’s not often that I hear mental health clinicians talking about it. I’m glad you are!)

You make a ton of excellent points. Too often people who have been stigmatized don’t speak out, so it’s great to see that. I completely agree with your point about diagnoses – in our agency, we give a preliminary diagnosis at intake and a psychiatrist’s diagnosis at the psychiatric evaluation. Each segment is only two hours long, and unless the therapist is completing the intake (which only happens if our intake coordinator is out and we end up taking that particular client on our caseload), the one person who sees the client most doesn’t get a say in the diagnostic process. I find it detrimental to give a potential lifelong label to someone after only meeting them for a few hours. Diagnoses can be helpful sometimes if it guides treatment appropriately, but only when it’s accurate, well-considered, and still takes humanity into account rather than reducing someone’s whole life to a label.

The problems with gun control are complex (and personally I’m not thrilled about the idea of anyone having guns, but that’s just my two cents), but to associate it directly with the broad term “mental illness” is unfair and stigmatizing. I hope one day that people can see that most people with mental illness don’t present as a danger to others.